Burden of Cancer Pain Worse in Some Countries

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci


November 17, 2016

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Hi. I'm David Kerr, professor of cancer medicine at the University of Oxford. I'm also editor-in-chief of the new Journal of Global Oncology (JGO), which is published online by the American Society of Clinical Oncology (ASCO). It's something I am rather proud of. The JGO aims to give voice to our brothers and sisters who practice cancer medicine in low- and middle-income countries under difficult conditions. I'd like to talk about one of the recent articles[1] published in JGO. It comes from a distinguished Indian group that performed a 6-month observational study trying to assess the burden of cancer pain in the patients coming to their cancer center in Punjab, India. They used a well-recognized tool, the Brief Pain Inventory and Pain Management Index, to assess the burden of pain. With the 348 patients that they studied, they found that three quarters of the patients had far from adequate pain control. Think about that for a moment.

Lack of access to morphine plays a huge part in this grossly inadequate pain control.

We know that up to 70% of all cancer patients experience pain at some stage throughout their cancer journey, at some stage in their disease.[2] We know that this is probably the most debilitating of all symptoms. Certainly, because cancer is still a stigmatizing disease, all of our patients come worried about a painful death. One of the promises that we can give to the wealthy nations in the West is that patients will not die in pain. With modern palliative care support and modern pain relief techniques, we can control pain in probably up to 90% of patients that we treat—a large gap. A part of that is due to the adequacy of access to morphine. Of course, there are other factors, such as expertise and so on, but lack of access to morphine plays a huge part in this grossly inadequate pain control [in other parts of the world].

There is something that we as citizens can do about it. We can lobby governments. We can support international agencies like the ASCO and the European Society for Medical Oncology (ESMO), who have a task force focused on delivering better palliative care. ASCO has a fantastic palliative care training program that has gained worldwide support and acclaim. People like Jim Cleary, a great friend of mine, are doing a wonderful job in terms of driving forward better access to morphine and, through that, improved pain control.

You have no idea how complicated it is in some countries to get morphine. Patients have to travel tens of miles to register at their local police station because of the legislation around control of access to morphine in some sub-Saharan African countries, for example.

This is a well-conducted study by an excellent group, with an extraordinary finding—the huge gap in pain control and therefore the inadequacy of Indian oncologists to be able to make the promise that we make to our patients: "We'll do our best to look after you, but I can promise that you will not die in pain." That promise cannot be held in many, many countries around the world. We need to consider how we can help promulgate the concept through policy, better access to drugs, and better access to training that cancer pain can be controlled and conquered.

Thanks for listening. As always, I'm grateful for any comments you might wish to post. For the time being, Medscapers, ahoy.


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